Crisis-repair sequences - considerations on the classification and assessment of breaches in the therapeutic relationship

<p>Abstract</p> <p>Background</p> <p>Recent research indicates that temporary deteriorations of variables monitored continuously in the course of the therapeutic relationship are important characteristics of psychotherapeutic change. These so-called rupture-repair episodes were assessed by different authors using different mathematical methods.</p> <p>Methods</p> <p>The study deals with the criteria for identifying rupture-repair episodes that have been established in previous studies. It proposes modifications of these criteria which prospectively could make it possible to identify rupture-repair episodes more precisely and consistently. The authors developed an alternative criterion. This criterion is able to include crisis patterns which had not been considered before, as well as to characterize the length of the crises. As a sample application, the different criteria were applied to continuously measured assessments of the therapeutic interaction in psychodynamic therapy courses (ten shorter processes and one long-term therapy).</p> <p>Results</p> <p>The analysis revealed that the number of the identified rupture-repair episodes differed depending on the criterion that was used. Considerably more crises were identified with the newly developed criterion. The authors developed a classification of crisis patterns. They distinguished five patterns of crises and their resolution in therapy processes and ascertained the frequency of distribution. The most frequent pattern was the simple V-shape. The second most common pattern was a decline over more than one session with a sudden repair. The longest downward trend comprised a period of six sessions.</p> <p>Conclusions</p> <p>The findings of the study give insight into basic mechanisms of change within the therapeutic relationship. A phenomenological discussion of how a crisis is defined is useful to create a methodological approach to the operationalization of crises, to differentiate specific characteristics and to specifically link these characteristics to the outcome in future studies. The methodological deliberations might be applyable to different research areas where the analysis of fluctuations in a variable of interest over time is relevant.</p

A Bottom-up Approach to assess Verbal Therapeutic Techniques. Development of the Psychodynamic Interventions List (PIL)

Mixed-Method-Design: In a comprehensive qualitative study, types of techniques were identified at the level of utterances based on transcribed psychodynamic therapy sessions using Qualitative Content Analysis (4211 utterances). The definitions of the identified categories were successively refined and modified until saturation was achieved. In a subsequent quantitative study, inter-rater reliability was assessed both at the level of utterances (n = 8717) and at the session level (n = 38). The convergent validity of the categories was investigated by analyzing associations with the Interpretive and Supportive Technique Scale (ISTS). The inductive approach resulted in a classification system with 37 categories (Psychodynamic Interventions List, PIL). According to their semantic content, the categories can be allocated to three dimensions: form (24 categories), thematic content (9) and temporal focus (4). Most categories showed good or excellent inter-rater reliability and expected associations with the ISTS were predominantly confirmed. The rare use of the residual category “Other” suggests that the identified categories might comprehensively describe the breadth of applied techniques. The atheoretical orientation and the clear focus on overt linguistic features should enable the PIL to be used without intensive training or prior theoretical knowledge. The PIL can be used to investigate the links between verbal techniques derived from practice and micro-outcomes (at the session level) as well as the overall therapeutic outcomes. This approach might enable us to determine to what extent the outcome of therapy is due to unintended or non-theoretically relevant techniques

Facilitative interpersonal skills performance test

It is of great importance to measure interpersonal skills of psychotherapists. One of the few instruments available to measure these skills is the Facilitative Interpersonal Skills performance test (FIS, Anderson et al. 2009), a test that has been found to predict psychotherapy outcome. We developed a German FIS version. Our work comprised the development of 13 video clips, the rater manual, a platform for online FIS assessments, and investigation of psychometric properties and predictors of therapist skills. This was the first out of two studies aiming at a psychometric analysis of the German FIS. We found a high inter‐rater agreement and internal consistency, as well as similar difficulties for all clips and no effects of clip position. This suggests that the FIS can be used for repeated assessments using distinct sets of clips. The FIS is of considerable benefit for standardized and empirically based measurement of interpersonal skills of therapist in research and training

Linguistic characteristics of a psychotherapy session sequence from the perspective of different analytical methods

Hintergrund Die sprachlichen Äußerungen sind ein zentrales Medium in Psychotherapien, d. h., Psychotherapie wirkt im Wesentlichen über die Sprache, über das Miteinanderreden. Angesichts der Bedeutung des sprachlichen Austauschs ist es relevant, die Mechanismen, über die Sprache in Psychotherapieprozessen wirkt, genauer zu verstehen. Die linguistische Psychotherapieforschung nutzt hierfür vielfältige Methoden. Ziel der Arbeit Vorliegender Beitrag demonstriert exemplarisch 2 mikroanalytische Ansätze. Material und Methoden Eine transkribierte Psychotherapiesitzungssequenz wurde aus Perspektive der psychodynamischen Theorie inhaltlich interpretiert und bezüglich sprachlicher Merkmale mithilfe von 2 Methoden mikroanalytisch beurteilt: Die verbalen Techniken (Fokus Therapeutenäußerungen) wurden mithilfe der Psychodynamischen Interventionsliste (PIL) geratet und eine detaillierte Konversationsanalyse (Fokus Dialog) erfolgte. Ergebnisse Analysen mit der PIL zeigten, dass im Sitzungsausschnitt überwiegend die Techniken „Bedeutung hinzufügen“ und „Wiederholen, Umschreiben, Zusammenfassen“ verwendet wurden. Thematisch wurde besonders auf den „Vater“ Bezug genommen, gefolgt von der „Therapeutin“. Der zeitliche Bezug lag schwerpunktmäßig in der „Vergangenheit“. Die Gesprächsanalyse rekonstruiert, dass der Wechsel auf die Erlebensebene die Therapiesituation selbst in den Fokus rückt. Mithilfe sequenzieller Handlungszwänge werden extratherapeutische Konstellationen in der Vergangenheit und therapeutische Gegenwart kontrastierbar sowie intersubjektiv bearbeitbar gemacht. Schlussfolgerung Die eigene Sprache und den Dialog im Therapieprozess zu beobachten, kann für Therapeuten aufschlussreiche Erkenntnisse über Folgen und Voraussetzungen eigener Interventionen liefern. Forschungen an der interdisziplinären Schnittstelle von Psychotherapie und Linguistik sind lohnenswert

Wie kann Reden heilen? Zur Sprache in der Psychotherapie

Psychotherapie gilt traditionell als 'talking cure', als Heilverfahren also, das wesentlich über Sprache operiert. Unklar ist allerdings, was diese Zuschreibung konkret bedeutet, insofern die therapeutische Wirkung von Sprache unterschiedlich expliziert wurde. Vor diesem Hintergrund rekonstruiert diese Studie zentrale Ansätze, die die 'talking cure' in Termini von 1. Katharsis, 2. Symbolisierung, 3. Metaphern, 4. verbalen Interventionen und 5. Narrativen beschreiben, und diskutiert diese im Hinblick auf Befunde der Psychotherapieforschung. Im Resultat ergibt sich ein komplexes Bild disparater theoretischer Zugriffe, die in der Grundannahme konvergieren, das therapeutische Potenzial von Sprache in ihrer Möglichkeit zur Explikation beziehungsweise zur Modifikation pathologisch-maladaptiver Erlebens- und Erfahrungskonstellationen zu sehen. Die empirische Befundlage bezüglich dieser Ansätze ist heterogen: Die meisten Typen verbaler Aktivität zeigen unklare Assoziationen mit dem Behandlungserfolg. Konsistenter sind Zusammenhänge mit Prozessvariablen, wobei spezifische Prozesse von unterschiedlichen verbalen Aktivitäten evoziert werden können (zum Beispiel Verstehen durch Übertragungsdeutungen, Selbstoffenbarungen, Metaphern oder Narrative). Weiterhin wurde gezeigt, dass verbale Aktivität auch negative Effekte haben kann. Insgesamt legen diese Befunde eine integrative Sicht auf die Sprache im Sinne eines Sets sprachinduzierter veränderungsrelevanter Prozesse nahe, deren heilsame Wirkung im Kontext eines umfassenden Beziehungsgeschehens zu betrachten ist und dabei komplexen Randbedingungen unterliegt, die zu präzisieren und systematisieren ein wichtiges Desiderat der Psychotherapieforschung darstellt

Testing ground GDR: Western pharmaceutical firms conducting clinical trials behind the Iron Curtain

Western pharmaceutical companies conducted clinical trials in the Eastern Bloc during the Cold War. Recently, media reports about alleged human experimentation provoked a wave of indignation. However, a scientific and objective account of these trials is lacking. The aim of this study was to describe and evaluate the clinical trials performed in the German Democratic Republic (GDR) based on archival material from the health system and the secret service. We found documents relating to 220 trials involving more than 14 000 patients and 68 Western companies. However, no record of patient information forms or systematic documentation regarding the provision of patient consent was discovered. There was no evidence to suggest that the trials systematically and intentionally damaged patients. The trials were conducted without the knowledge of the public. GDR legislation stipulated that patients must consent to the trials, but no evidence was found to suggest that patients were systematically informed. Documents suggest that at least some of the trials were carried out without patients having a comprehensive understanding of what the trial involved. The GDR agreed to the trials due to impending bankruptcy and Western pharmaceutical companies capitalised on this situation